National Information Center on Health Services Research and Health Care Technology (NICHSR)

Practical Approaches for Using Health Indicators Transcript

Event Started: 2/3/2010

Hello and welcome to the 3rd of the 4-part Health Indicators webinar series brought to you by the National Information Center on Health Services Research and Health Care Technology (NICHSR) and the National Library of Medicine. We are delighted to introduce Nancy Allee, our presenter today, who will provide practical guidance for librarians on how they can engage with their local health departments and organizations to improve community health. Examples from the Community Health Status Indicators Project and efforts of a library project underway will be highlighted. Nancy is the Deputy Director of the Health Sciences Libraries at the University of Michigan, holds both M.L.S. and M.P.H. degrees, has extensive experience and expertise in public health education and training, and has participated in numerous outreach projects for public health professionals including using web technologies to engage the public health workforce and the communities they serve. Go ahead Nancy.

Welcome everyone. I am Nancy Allee and I will be talking with you today about practical approaches for using health indicators and for promoting librarian and public health partnerships. This webinar is part 3 of a 4-part series on health indicators sponsored by the National Library of Medicine (NLM). The first webinar which Cheryl Wold presented on January 20th provided an excellent overview of health indicators. The second webinar presented on January 27th focused on the Community Health Status Indicators Project. After today's session, there will be one more webinar in the series which will cover several important new indicator projects. The date and time for the webinar will be announced as soon as it is able to be scheduled. At the completion of the series all of the webinars will be archived and available from the NLM website. The first webinar has already been archived and can be accessed at the address provided on screen. You can listen to the recording, view the PowerPoint slides and read the transcript. Answers to the questions asked during the webinar are also provided. If you view the webinar and evaluate it, you are eligible to receive one hour of MLA CE credit.

Today's presentation is organized into three parts. First we will cover practical ways in which the Community Health Status Indicators, also known as CHSI, can be used. As part of this, we will do a quick review of CHSI for those in the listing audience who may have missed last week's webinar. Next we will look at some of the National Library of Medicine and National Network of Libraries of Medicine resources which are complementary to CHSI and which are important for the public health research and practice communities. For part three, we will finish up by talking about how librarians can foster successful, productive partnerships with the public health community. As part of this discussion, we will focus on a project that I'm familiar with which is our University of Michigan Health Sciences Libraries' project on Public Health 2.0.

Before we begin, just a few comments about my background and interest in this area. I have degrees in both library science and public health. I have taught or co-taught several CE courses for the Medical Library Association, including ones on Community Health Status Indicators, evidence-based public health, and public health 2.0. I have also worked many years with NLM and the Partners in Information Access group to provide training resources for the public health community.

To get started, and so that we are all on common ground, we will just briefly review the Community Health Status Indicators focusing on four questions. What are health indicators in general? What are the Community Health Status Indicators? What is meant by peer counties and lastly what are some of the uses of CHSI and who is its user community?

Here are definitions of indicators and health indicators. Health indicators can include measurements of illness or disease such as birth and death measures like infant mortality and the National Leading Causes of Death as well as individual behaviors which are related to health, such as smoking, diet and nutrition, and exercise. Indicators can change over time. Information provided by health indicators can be used to improve physical and mental health of individuals as well as their quality of life and risk for illness and death. The environmental health of a community can also be improved using health indicator data.

As we discussed last week, CHSI is a collection of nationally available health indicators for counties helping to present a total picture of local health. It is a resource for monitoring and analyzing community health status and its determinance at the county level. And CHSI is a valuable resource that supports the mission and goals of public health, the 10 Essential Public Health Services, Healthy People 2010 initiatives, and evidence-based policy and research. When we are talking about the health of a community, community is being defined in the Community Health Status Indicators at the local level of counties. The CHSI reports tell the story of the health status of individual counties. There are data for 3,141 individual counties within the United States which are included in CHSI.

CHSI includes listings of peer counties for the individual counties. Peer counties are counties which are similar in population size and other selected characteristics, such as poverty level, age distribution and density. This is important because one of the primary purposes of collecting statistics is to be able to make comparisons. It can be helpful for counties to be able to compare their health status to those of other counties with similar population characteristics.

Note also that CHSI has a very diverse user community. It can be used to develop public policy, public health programs and interventions, public health partnerships, and the data can support research, grant funding efforts and a variety of publications. Users of CHSI come from the public health, library and academic communities as well as government and nonprofit organizations. And because CHSI is freely and publicly available on the web, it is a resource that can be used by anyone with an interest in local public health data.

One of the key features of CHSI is that you can get all of this information as one comprehensive report for your county of interest. And you can print the report as a PDF which will include numbers, tables and charts about the health of the community. We will talk later in the webinar about how librarians are using the CHSI reports in their training classes for public health practitioners.

CHSI is easily accessed on the web from the website of the Department of Health and Human Services at the web address provided (http://www.communityhealth.hhs.gov). CHSI has a very user friendly interface and is easy to search.

Last week we talked in detail about the different kinds and sources of data in CHSI. Today, we will focus on the Community Health Status Reports and how these can be used by and with the public health community. From within the CHSI website, there is a link to a page with information and ideas about how to use your county's report.

One practical approach to using the CHSI reports is to spread the word and celebrate the good news about the community's health status. You will note that in the CHSI reports, an Apple indicates favorable health status and a Magnifying Glass indicates areas where improvement is needed. The symbols are very visually clear and help in quickly identifying health status for the community for specific indicators. Librarians can help public health celebrate the good news about favorable health indicators and they can also help in terms of providing access to research and model programs which address areas of unfavorable status. These are helpful suggestions for sharing information between peer counties so that some of the reasons for the differences between health status might be better understood and so that health challenges can be addressed by looking at model programs.

This slide emphsizes the different audiences with whom the CHSI reports can be shared: Board members, city council members, legislators, schools, and other colleagues in public health related program areas. Emphasis is also placed on the fact that improving health status is a team effort and librarians are part of this team effort. There are many ways that the CHSI reports can be shared and this slide identifies some of these audiences. Librarians have a very valuable role to play in helping CHSI audiences identify additional resources addressing the health status indicator data. We will talk more later about NLM resources that supplement the CHSI data resources.

This is an important message about the CHSI reports. The information they contain is designed to be integrated into existing health planning and assessment initiatives. For example, the CHSI reports include data relevant to the Healthy People 2010 targets. The National Association of County and City Health Officials has some excellent information to supplement the CHSI reports - including a sample press release for local health departments to use when disseminating information regarding the CHSI reports as well as suggested talking points for explaining the content and purpose of the reports.

Now, we will switch gears from talking about how the health status indicators can be used by and with the public health community to focus on the health information resource links that are featured on the Community Health Status Indicator's website from the National Library of Medicine. The NLM resources page identifies a set of web-based resources which have been carefully selected as being complementary to CHSI. The categories of resources are: general resources, consumer resources, public health resources, and training and evaluation resources. There are links to 27 different resources. We will spend some time today looking specifically at the11 resources which are identified as being especially relevant to public health practitioners. If you are doing a training session for your local public health department on health status indicators, these would be among the resources it would be most useful to present.

First, from the NLM resources section in CHSI, you can link directly to a search in PubMed on the topic of community health status indicators. This screen shows the search details on the topic which combines an ALL FIELDS search on community health status indicators -- with MeSH major topic searches on community health planning and health status indicators. From the results page, you see that there are currently 46 articles in PubMed on community health status indicators using our selected search terms. Nine of the articles are review articles and 15 are available as free full-text. This information can be helpful to demonstrate when doing training sessions on CHSI so that the public health practice community is aware of how they can easily find more information on health status indicators. This is one of the articles retrieved from the search. It is a UK study from 1998 in the journal Quality and Health Care focusing on what health authorities think about health status indicators. You will note that one of the findings is that interviewees were interested in comparative data for districts with similar population structures. This illustrates again the importance of the concept of peer counties in the community health status indicator reports and how helpful comparative health data can be to public health practitioners. The information about peer counties can be helpful to demonstrate when doing training sessions on CHSI so that the public health practice community is aware of counties with similar population demographics to their own.

As we mentioned earlier, there are 11 resource links within CHSI provided within NLM which are especially relevant to public health. They are listed in alphabetical order and the first six are identified here. These resources focus on environmental health information and health services research information. The remaining five public health resources are listed here and they include health disparities information and outreach to special populations, as well as the Partners in Information Access resources. We will spend a few minutes looking at each of the resource website gateway pages individually and cover in a little more detail the information they provide access to.

This site was created by the National Library of Medicine's Long-Range Planning Committee to help with national emergency preparedness and response efforts. The Disaster Information Management Research Center is responsible for the collection, organization and dissemination of health information resources and research related to disasters of natural, accidental or deliberate origin. These essential information resources are provided to help prepare, respond to and recover from the adverse health effects of disasters, working in coordination with federal, state, local governments, private organizations and local communities. The website and its resources are designed to be directly beneficial for public health officials, health care providers, special populations and the public.

This site provides links to resources on toxicology and environmental health issues of recent interest such as H1N1 or swine flu information, as well as disaster recovery information on topics such as hurricanes, tornadoes, and wildfires.

This site is a portal to information on environmental health and toxicology, featuring links to information on chemicals and drugs, poisoning, risk assessment and regulations, and pesticide exposure among others. Access is provided to Toxnet -- a collection of databases covering toxicology, hazardous chemicals, environmental health, and toxic releases. Access is also provided to Tox Town -- an interactive guide to potentially toxic substances and environmental health issues in everyday places. Tox Town also offers some resources in Spanish. The website provides information targeted to specific audiences, including researchers and scientists, health professionals, educators and students, emergency responders, and the general public. If you use social media, you can also follow developments about the site on Twitter.

The Healthy People 2010 Information Access Project is a popular web-based resource, developed by the National Library of Medicine with the help of subject experts and public health librarians that provides automatic links to PubMed searches for selected Healthy People 2010 objectives. The purpose of the project is to make it easier for the public health community to quickly find current information from published and evidenced-based literature in support of achieving the Healthy People 2010 objectives. This page shows the links to seven PubMed searches for the Healthy People 2010 objectives related to the Nutrition and Overweight Focus Area. Links are provided to articles addressing adult obesity, children and adolescents are overweight, increasing the good dietary quality of meals and snacks at school, increasing the number of worksites offering nutrition and weight management classes or counseling, and increasing food security in U.S. households. In addition to the links to PubMed searches, links are also provided to the specific Healthy People 2010 objectives focusing on the Nutrition and Overweight Focus Area.

This site provides access to information about ongoing research projects prior to their publication. This kind of information can be particularly valuable to help policymakers, health administrators, clinicians and researchers. Descriptions cover both grants and contracts awarded by major public and private funding agencies and foundations. Information includes sponsoring agencies, names and addresses of the principal investigator, beginning and ending years of the project, information about study design and methodology, including demographic characteristics of the study group, number of subjects in the study population, population-base of the study sample, source of the project data and project descriptions. The site also has a state mapping feature that shows brief record displays of projects being performed in a particular state.

This site is a searchable database of descriptions of research datasets, research instruments and software used in public health, health services research, and the behavioral sciences. The site was designed for the benefit of health care researchers and health sciences librarians needing access to these types of resources. The kinds of research resources included in the database are clinical records, discharge summaries, claims records, epidemiological surveys, health behavioral social surveys, disease registries, birth registries and data about practitioners, programs and facilities.

HSTAT is a web-based resource of documents that provide health information in support of health care decision making. HSTAT's audience includes health care providers, health services researchers, policymakers, consumers, and the library and information professional who served these groups -- examples of the some of the documents available in the HSTAT database include: evidence reports and technology assessments from the Agency for Healthcare Research and Quality, the National Institutes of Health consensus conference reports and technology assessment reports, HIV/AIDS Treatment Information Service, federally approved treatment guidelines and information, the Substance Abuse and Mental Health Services Administration's Treatment Improvement Protocols and Prevention Enhancement Protocol System, and the U.S. Preventive Services Task Force's Guide to Clinical Preventive Services.

NLM also provides links to a variety of resources on health disparities and minority health information. Some of these resources include a link to a pre-formulated PubMed search on health disparities, MedlinePlus for specific populations, the NLM Strategic Plan for Addressing Disparities, the NIH Plan to Reduce Health Disparities, and the Agency for Healthcare Research and Quality's National Healthcare Disparities Report, in addition to information resources from other selected associations, foundations and research centers.

NLM's Office of Outreach to Special Populations improves access to toxicology and environmental health information to underserved communities, health related disaster information in Central America, HIV/AIDS information resources by community-based organizations, and health information for all minorities and underserved populations.

The PH Partners website offers a wealth of information, both for the public health community in general and in support of librarians working with public health colleagues on public health initiatives. PH Partners is a collaboration of U.S. government agencies, public health organizations and health science libraries for the purpose of providing timely, convenient access to selected public health Internet resources. The PH Partners website is organized by the following categories of information resources: health promotion and education, literature and guidelines, health data tools and statistics, grants and funding, education and training, legislation and policy resources, conferences and meetings, finding aids, discussion and e-mail lists, and job and career resources.

Toxmap is a geographic information system that uses maps of the United States to illustrate data from the Environmental Protection Agency's Toxic Release Inventory and Superfund program. Federal law requires facilities in certain industries that use significant amounts of toxic chemicals to annually report on the releases of these chemicals to the EPA. Superfund sites exist throughout the United States and contain substances that are designated as hazardous. Using Toxmap, individuals can create nationwide, regional or local area maps showing where toxic chemicals are released into the air, water and ground. It also identifies the releasing facilities, color codes release amounts for a single year or year range and provides multi-year aggregate chemical release data and trends over time, starting with 1988. Maps also show locations of Superfund sites on the National Priority List, identifying all chemical contaminants present at these sites. Users can search the system by location, chemical name, release amount and facility name. Toxmap also overlays map data such as U.S. Census population information, income figures from the Bureau of Economic Analysis and health data from the National Cancer Institute and the National Center for Health Statistics.

Now we are going to move into the final segment of the webinar, which is a focus on librarians and partnerships to provide public health information and to work closely with the public health practice community. We will be defining partnerships broadly -- from ones that focus on training and community health status indicators to resources for working with public libraries to provide consumer health information to partnering with the public health community on social media, looking at a case study from the University of Michigan Health Sciences Libraries.

I want to first share information from Cheryl Rowan who is the Public Health Outreach Coordinator at the National Network of Libraries of Medicine, South Central Region, located in Houston, Texas, at the Texas Medical Center Library. Cheryl contacted me after last week's webinar on CHSI to share how her library uses this resource. Cheryl is one of the staff who teach a class called Public Health Information on the Web which is structured around the PH Partners website as a guiding framework. Cheryl shared that both she and the public health participants in the class love CHSI and that people get excited about the county level data and especially about finding their peer counties and being able to compare their county's health status to that of their peers. The South Central Region covers five states and Cheryl said that when she does training sessions, she will take print copies of the CHSI reports for the counties she is teaching in -- Tulsa for Oklahoma, and El Paso and Houston for Texas, for example. Cheryl mentioned that Texas is a very diverse state and that the health status reports can vary widely for border counties such as El Paso compared to inner cities like Houston. Cheryl said it is very valuable to public health participants in her class to be able to drill down to the county level, rather than having just state-level data. In addition, when exhibiting at state public health association meetings, they have printed out copies of the CHSI reports and distributed them where they have been very well received. Because of the success and popularity of the public health course, a new course is being developed by the office which will delve into health statistics at a deeper level. CHSI will also be included as a part of the class. Thank you Cheryl for sharing this information with us.

The National Network of Libraries of Medicine (NN/LM) encourages health information partnerships between public libraries, NN/LM, and local health or community-based organizations and they have some practical, healful resources available from their website. Public libraries are an essential part of their communities. They serve an important role in helping people access needed services and resources, enhancing information sharing, referral, and collaboration among community agencies, and providing information that helps people make informed decisions. NN/LM provides a set of resources focused on community assessment, defining stakeholders, developing project goals and defining outcomes as well as preparing evaluations plans, and NN/LM provides information about funding opportunities for partnerships.

This series of guides from the NN/LM Outreach Evaluation Resource Center provides step-by-step planning and evaluation methods. Each booklet also includes a case study and worksheets to help with outreach planning. The three-part booklet series is designed to supplement the Measuring the Difference Guide to Planning and Evaluating Health Information Outreach, which is a very useful resource for designing the health evaluation components of library and public health partnership projects.

The next part of the webinar focuses on a case study of the University of Michigan's Health Sciences Libraries partnership with the public health community in Michigan. This slide shows the groups we partnered with on the "Creating a Roadmap Local Public Health 2.0 Project". The Public Health 2.0 project with a collaborative effort between the University of Michigan Health Sciences Libraries, the School of Public Health and its Prevention Research Center, and the Genesee County and Munro County health departments. The overall purpose of the project was to develop best practices for integrating Web 2.0 technologies into the work of local public health departments and to improve the communication and information sharing within the department, between partner organizations, and for the populations that they serve. The Public Health 2.0 project was funded by a public health subcontract from the National Network of Libraries of Medicine, Greater Midwest Region. There were four primary goals for the Public Health 2.0 project. For the first goal of assessment, a needs assessment was conducted to identify the ways in which Web 2.0 technologies might increase the efficiency and effectiveness of each department's communication and information sharing. The second goal of training involved providing a series of workshops to train staff in skills and strategic uses of Web 2.0 technologies. The third goal of collaboration and integration focused on partnering with public health staff, committees, and their public health departments as a whole, to integrate specific, selected technologies into their work.

Communication was an essential element of the Project. When we first met with one of our partner organizations, the Genesee County Public Health Department, they were just beginning work on a new communication plan for the department. They felt that thinking about how Web 2.0 and social technologies might be incorporated into their overall communication and information sharing methods would be an important component of their strategic planning. They invited us to their department retreat so we could be part of the process from the very beginning. As part of the needs assessment, we conducted a survey of staff at each of the public health departments that we were parting with. The survey instrument included 50 questions and was available online by a survey monkey. We had a 73% response rate to the survey.

Here is an example of one of the survey questions asking which types of Web 2.0 technologies public health staff have used during the past 12 months. When we asked how comfortable public health staff felt about learning new technologies, approximately 1/3 reported feeling either very uncomfortable or uncomfortable. However, 97% reported being interested in learning about new technologies. In this survey, we asked which specific technologies public health staff used and this chart gives a snapshot of social media used at the time within each of our partner organizations. As you can see, two years ago when we began the project, no one at either health department used Twitter. Very few staff used Google Docs, although when training was provided on it, staff could see a lot of possibilities for its use. Less than 20 staff were using Facebook at the time of the survey, however, YouTube and Wikipedia were very popular.

Training for the Public Health 2.0 project began with a two-hour training session in which health sciences librarians defined Web 2.0, including which technologies are involved, such as blogs and wikis and collaborative writing tools, and how these technologies could be applied to local public health practice. The training also included a brainstorming session in which public health staff discussed how they could apply Web 2.0 technologies to their specific areas of interest. Following this training, the group met to discuss among themselves which projects they would like to pursue with the help of the library project team. Librarians worked with public health staff to finalize the list of projects and then organize training for small groups. Projects included creating a staff blog using Blogger, an intranet using Google Sites, a collaborative writing space using Google Docs, a wiki-based policy manual on Google Sites, and a Google Calendar for shared events and scheduling. The decision to have an all-Google technology suite was based on a strong desire to simplify the process and the number of usernames and passwords needed.

This page shows the Genesee County Health Department's intranet site that resulted from the Public Health 2.0 partnership. Using a Google apps site, librarians incorporated a staff blog, shared Google Calendar, online policy wiki, and Google Docs into an easily editable website. The site has been made the homepage of all staff machines at the Health Department. The home page has links to all of the resources, in addition to a variety of pages linking to useful online resources for various divisions within the department. The staff blog include announcements of staff training sessions, new policies, personal announcements, news and information of interest to the staff, and wellness tips. The online policy manual is a wiki that is editable by all Health Department staff and staff were particularly interested in the ability to search the manual by keyword. Results of the Public Health 2.0 project have been presented in posters and papers at a number of conferences and professional meetings. Both PowerPoint slides and the conference paper about the project are available from the International Congress on Medical Librarianship website at the address listed and can be downloaded as PDF documents if you are interested in more information about library and public health partnerships using social media.

Another social media resource to mention is a video highlighting Second Life and Public Health that we have also produced and that is available from our website. As you know, Second Life is a virtual world and there is an active public health community developing resources in Second Life, such as simulating disaster scenarios, creating interactive health games, offering people with disabilities a place for support and social networking, and providing a space for professionals to view presentations and attend international conferences. This video showcases some of the potential of virtual worlds as applied to public health. It is a little over four minutes in length and can be easily integrated into training sessions. Please feel free to use this as a resource for your work with the public health community if you are interested in virtual worlds.

I would like to share a few suggestions in terms of practical approaches to partnering with public health departments. It is important to establish buy-in from department leadership before a project can begin. For our project, we established a primary contact with the Supervisor of Development, Planning and Grants in one department, and at the other, we worked closely with the Health Officer. It is also important to be responsive to the priorities and needs of the public health department. Our Public Health 2.0 project was a good fit or one of our partner organizations in particular, because it integrated well with their overall strategic planning and efforts to revise their department's communication plan. When working with 2.0 technologies, creative problem solving is needed to work toward solutions for concerns involving security, bandwidth, and external hosting of information, among other technology issues. Public health departments may be facing budget and staffing constraints -- being able to identify financial resources to facilitate an initiative can make a vast difference in a department's ability to participate.

In summary for today's session, we covered three areas: practical approaches for using CHSI data, information about NLM resources complementary to CHSI which can be used in training sessions with public health practitioners, and practical approaches for promoting library and public health partnerships, including a case study on a Public Health 2.0 partnership project at the University of Michigan Health Sciences Libraries.

One feature of a webinar is that it can be interactive - so we can have a discussion on the themes we have been discussing today. We have talked about the work that librarians are doing to promote training resources for the public health community. Here is a quote from Richard Horton writing about libraries in Lancet. He writes that "in the health community today, librarians are too quiet", and he suggests that they become more visible and more active in the health arena, particularly in helping to improve health literacy, and helping address global health issues. Do you agree or disagree that librarians are too quiet about their roles in the health community and why or why not?

We are probably all familiar with the 10 Essential Public Health Services that provide a working definition of public health, as well as providing a guiding framework for the responsibilities of public health systems. The Public Health Functions Steering Committee, with representatives from the U.S. Public Health Service and other major public health organizations developed the framework for the Essential Services in 1994. Another question for you today is, &auot;would it be helpful, in supporting and encouraging partnerships between libraries and public health, for us to have a companion document to the 10 Essential Public Health services, which talks specifically about contribution that librarians can make?" I would like to hear your feedback on the seven ideas so far and to get your ideas about what else should be included. If you are interested in helping to develop this document, please send me an e-mail. The next steps would be to share this draft document with the Medical Library Association Public Health/Health Administration section for their review and feedback. And then to also share the document with the Public Health Partners group.

As a reminder, there is one last webinar in NLM's four-part series. The date will be announced as soon as it can be scheduled. It will be a very interesting session covering new indicator projects, including State of the USA and MATCH.

Thanks everyone for your participation. Here is my contact information if you have any questions about today's webinar on Practical Approaches for Using Health Indicators and for Promoting Librarian and Public Health Partnerships. And just as a reminder, the PowerPoint slides, transcript and archive of the webinar will be available from the NLM website.

I will post responses to the questions on the FAQ which will accompany the webinar. Now I will turn this over to Kate who will wrap up today's webinar session.

Thank you Nancy and thank you all for your participation. I will now direct you to our short evaluation form. I have put two links on your screen, one is to the website and the other is to be the evaluation form. When I close the meeting, your screen will be automatically be directed to the evaluation form. Thank you and we will see you for part four of the webinar series.